Beyond the Healing Garden

Posted by Kent Doss on Apr 05, 2013

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Hands holding budding plants

Healing the Body by Healing the Earth as Part of a Comprehensive Cancer Program

Featured by Medical Construction + Design in February 2014.

The term “biophilia,” which literally translates as “love of life or living systems,” is used to describe the theory that suggests that there is an instinctive bond between human beings and other living systems and that this bond is essential to good physical and mental health. [1] We have a natural attraction to all that is alive and vital - all humans have “the urge to affiliate with other forms of life” [2]. This premise helps explain why ordinary people spend time and energy caring for plants and flowers in their homes…in other words, our natural love for life helps us sustain life.

Since these ephemeral theories were first postulated in the 1980s, scientific research has served to validate the measurable benefits of connecting with the natural world. As evidence-based designers, we challenge ourselves to go beyond the standard, simple visualization of nature in the built environment (i.e. façade fenestration that harvests natural light and views, nature inspired artwork, organically-inspired forms, etc.) and provide actual physical links to nature. A recent article in the New York Times touted the health benefits of immersing oneself in the natural environment:

Spending more time in nature might have some surprising health benefits. In a series of studies, scientists found that when people swap their concrete confines for a few hours in more natural surroundings — forests, parks and other places with plenty of trees — they experience increased immune function.

Stress reduction is one factor. But scientists also chalk it up to phytoncides, the airborne chemicals that plants emit to protect them from rotting and insects and which also seem to benefit humans.

One study included data on 280 healthy people in Japan, where visiting nature parks for therapeutic effect has become a popular practice called “Shinrin-yoku,” or “forest bathing.” On one day, some people were instructed to walk through a forest or wooded area for a few hours, while others walked through a city area. On the second day, they traded places. The scientists found that being among plants produced “lower concentrations of [the stress hormone] cortisol, lower pulse rate, and lower blood pressure,” among other things.

A number of other studies have shown that visiting parks and forests seems to raise levels of white blood cells, including one in 2007 in which men who took two-hour walks in a forest over two days had a 50-percent spike in levels of natural killer cells. And another found an increase in white blood cells that lasted a week in women exposed to phytoncides in forest air. [3]

In our industry, one service line that has embraced this theory is cancer care. Almost every modern cancer center integrates some type of healing or meditation garden into its design in order to incorporate the life-affirming benefits of connecting with nature into the continuum of care. For many patients their time in this environment has become an intrinsic and indispensable part of their recovery or life transition process.

However, to fully harness the healing potential of nature, we can go beyond basic “ecopsychology” (i.e. our psychological relationship with nature) into the participatory realm of “ecotherapy:”

As an umbrella term for nature-based methods of physical and psychological healing, ecotherapy points to the need to reinvent psychotherapy and psychiatry as if nature and the human-nature relationship matters. It takes into account the latest scientific understandings of our universe and the deepest indigenous wisdom. This perspective reveals the critical fact that people are intimately connected with, embedded in, and inseparable from the rest of nature. Grasping this fact deeply shifts our understanding of how to heal the human psyche and the currently dysfunctional and even lethal human-nature relationship. It becomes clear that what happens to nature for good or ill impacts people and vice versa, leading to the development of new methods of individual and community psychotherapeutic diagnosis and treatment.

Ecotherapeutic work takes guidance from an Ecological Circle of three mutually interacting operations or dynamics:

Inreach: receiving and being nurtured by the healing presence of nature, place, Earth.

Upreach: the actual experience of this more-than-human vitality as we relocate our place within the natural world.

Outreach: activities with other people that care for the planet.[4]

The application of these theories into actual practice includes several guiding values for caregivers that are very much in alignment with the physical and mental needs of cancer patients:

  • Because human beings are an integral part of the natural world, what nourishes or diminishes that world nourishes or diminishes us.
  • Ecotherapy recognizes and seeks to address how the pain of the ecological world shows up as pain within and between human beings.
  • All our work unfolds within an Ecological Circle that ethically links receiving and experiencing healing from nature, place, and Earth with giving something substantial back to the earthly sources of healing.
  • The Circle underlines the personal and collective need to transition from spectators, exploiters, and destroyers of the natural world into appreciators, lovers, advocates, and witnesses building a consciously regenerative relationship with that world.
  • Relationships of healing with nature, place, creatures, and Earth require us to acknowledge our participation in industrial, governmental, or organizational actions that harm the environment and to seek alternative actions whenever possible.
  • This relationship holds diversity (cultural, ecological, epistemological, spiritual, etc.) to be a precious source of enrichment, value, and, ultimately, survival. The more diverse the ecosystem, the greater its resiliency, creativity, and resourcefulness.
  • Although ecotherapy interventions tend to be much less invasive than drugs or psychotherapy, ecotherapists always put the well-being of clients first and carefully monitor potential safety and health concerns.
  • Ecotherapists believe that nonhuman forms of life have a right to exist for their own needs and purposes, and that this right includes leaving plant and animal ecocommunities intact and protecting the needs, health, and sense of agency of our animal companions in our work.
  • Ecotherapists regard their work as part of an ongoing collective effort to build just and sustainable communities in which all forms of life can delight and mature. [5]

While it might be tempting to dismiss the use of ecotherapy as “tree-hugging” nonsense, there is an impressive research database affirming the psychological and physical benefits of gardening therapy. Ecotherapy work has been shown to ameliorate depression, lower blood pressure, enhance self-esteem, encourage new social behaviors, help with impulse control, and decrease post-operative recovery time. Psychotherapy patients, the elderly, people suffering from post-traumatic stress, and patients with mood disorders (all common conditions in cancer patients) have offered favorable reports about ecotherapeutic work. [5]

Some healthcare providers have even begun giving their patients "nature prescriptions" to help treat a variety of medical conditions, from post-cancer fatigue to obesity, hypertension (high blood pressure), and diabetes. Scientists have long known that sunlight can ease depression, especially seasonal affective disorder (SAD). New research is expanding those findings. A 2007 study from the University of Essex in the U.K., for example, found that a walk in the country reduces depression in 71% of participants. The researchers found that as little as five minutes in a natural setting, whether walking in a park or gardening in the backyard, improves mood, self-esteem, and motivation.

Incorporating an ecotherapy program into a care plan is not dependent upon an abundance of available land or capital funding. The beauty of these programs is that they can be scaled to suit suburban and rural facilities with lots of landscape space or to challenging urban sites through the use of small container gardens or landscaped roofs. The effectiveness of a program is not generated by lavish facilities or excessive funding, but rather by the active participation of patients (both past and current); in fact, the starting point for such a program can often be a neglected, ignored, or underutilized area that can be “healed” by those working the land.

The detailed design of an ecotherapy garden is something that will be unique to your care program and your physical location. At their core, ecotherapy gardens should be functional, accessible, easily maintained, environmentally sound, cost effective, visually pleasing, and most importantly, supportive of your healing process. While the selection of species will be influenced by your Plant Hardiness Zone, solar exposure, and access to water, they can also be specifically aligned to support the functional needs of your patients:

  • The healing and recovery process can be symbolized by choosing plants that have traditional, medicinal properties such as Aloe Vera, Sage, Lemon Balm, Milk Thistle, or Comfrey.
  • Aromatic plants and flowers such as Chamomile, Lavender, Marsh Mallow or Peppermint can be utilized as a gentle, effective way to improve mental and emotional imbalances, enhance wellbeing and creativity.
  • Vitamin and antioxidant-rich fruits and vegetables like oranges, strawberries, spinach or artichokes can be incorporated into a dietary educational program.
  • The garden setting can be an inspirational setting for complementary alternative therapies like meditation, relaxation, visualization, or yoga.

Obviously, due to their unique disease and immune performance states, some patients may be prevented from being fully immersed in a garden environment, however visual access to the garden can still provide enrichment to this population. When combined with the astounding technological advances of modern medicine, an ecotherapy program can become a valuable piece of a comprehensive plan that cares equally for mind, body and spirit.


  1. Fromm, Erich (1964). The Heart of Man. Harper & Row
  2. Wilson, Edward O. (1984). Biophilia. Harvard University Press
  3. O’Connor, Anahad (2010). The Claim: Exposure to Plants and Parks Can Boost Immunity. The New York Times
  4. Clinebell, Howard (1996). Ecotherapy: Healing Ourselves, Healing the Earth. Routledge
  5. Buzzell, Linda and Chalquist, Craig (2009). Ecotherapy: Healing with Nature in Mind.

Topics: Architecture, Evidence Based Design (EBD), Healthcare Design, ecotherapists, Cancer Care, ecotherapy, biophilia, hospitals, nature prescriptions, Continuous Improvement, Healthcare, Healing Environment, healing garden

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